Moderating Effects of Gender Equality On Responsiveness and Patients

Moderating Effects of Gender Equality on Responsiveness and
Patients’ Satisfaction
Abdullahi Dauda1 , Sunday Alewo Omale1 , Abdullahi Mohammed2
1
Federal University Gashua, Nigeria
2
Nasarawa State University, Nigeria
Abstract
When a patient is satisfied with the services of the
healthcare providers, he or she would recommend such
healthcare outfit to others for patronage. This would
certainly improve the revenue base of the organization. The
Received 21 January 2022
intent of the study was to look at the moderating effect of
Revised 17 February 2021 gender equity on responsiveness as well as patient’s
Accepted 22 April 2022
satisfaction in the healthcare institution. A prearranged
questionnaire was adapted for this research and used to
solicit information from the participants of this study.
Furthermore, survey and cross-sectional research design
was employed. Likewise, probability sampling method was
adopted. Data analysis was conducted using Partial Least
Squares Structural Equation Modeling (PLS-SEM), and
Citation: Dauda A., Omale S. A., &
Mohammed A. (2022). Moderating effects of
SmartPLS 3.0. Outcome of the study shows a considerable
gender equality on responsiveness and correlation involving responsiveness as well as patients’
patients’ satisfaction. Journal of
Management, Economics, and Industrial satisfaction. Similarly, the finding shows that gender did
Organization, 6(2), 83-97. not significantly moderate the correlation involving
http://doi.org/10.31039/jomeino.2022.6.2.6
responsiveness as well as patients’ fulfillment in Federal
Medical Centre, Keffi, Nasarawa State. The article play an
important role as well as contribution’s that may be helpful
in the course of decision making concerning service
quality, customer happiness, among others working in
FMC, Keffi, Nasarawa State. The researchers concluded
Copyright: © 2022 by the authors. that the variable used to assess patients’ satisfaction would
This article is an Open Access article
distributed under the terms and conditions
make great impact on the patients if properly cared for by
of the Creative Commons Attribution the management. We recommended that the management
(CC BY) license should employ gender differences between males and their
(https://creativecommons.org/licenses/by/4.0/).
feminine counterpart patients to improve on
responsiveness and customers’ satisfaction.
Keywords: Moderating effects, Gender equality,
Responsiveness and patients’ satisfaction, Healthcare
institution.
corresponding author:
drsaomale@gmail.com JEL Classification Codes: J16, J17, J18, J10.
Dauda A., Omale S. A., & Mohammed A. (2022). Moderating effects of gender equality on responsiveness and patients’ satisfaction. Journal
of Management, Economics, and Industrial Organization, 6(2), 83-97. http://doi.org/10.31039/jomeino.2022.6.2.6
1. Introduction
Clients otherwise refers to as patients in this study are critical aspect of any functional system
as their existence create demand for the organization’s while their absence renders any
organization ineffective. Gender equality remains a basic human right as well as indispensable
basis designed for a purposeful, successful as well as sustainable organization, as legislation
are being renewed to press forward gender equality. Regardless of these benefits, biased laws
as well as societal norms remain persistent.
According to Ridhwan, Aziz, Shukor & Abdullah (2014), the desire by clients particularly, in
healthcare segment; in support of enhanced excellence performance have shaped the spirited
surroundings globally. Excellence performance represents the extent through which
organization caries out their duties that meet clients’ desires (Chao, Wu & Yen, 2015). O’Neill
(2000) stresses that, there is concern about the dimension of performance excellence that is
reasonably high, while measuring the superiority of performance experience is now an essential
part of good number managers’ tasks. However, the dispute is to discover as well as put into
practice the most suitable indicators to improve customers’ satisfaction in organizations.
Excellent service organizations consider it essential in tracking consumer satisfaction as an
important strategic success indicator and customers’ satisfaction (patients’ satisfaction) has
been identified as critical to improving corporate image in a global market arena (Shostack,
1985; Siddiqi, 2010; Stiglingh, 2013). Thus, Abdul Aziz (2016) maintain that customers’
contentment is the measurement of how performance provided by an organization is in line
with customers’ desires or prospect. Therefore, the extent to which clients see hospitals’
offering deserved careful consideration. Scholars such as Parasuraman, Zeithaml & Berry
(1990) consider customers as the only moderator of performance excellence. Based on the
extent to which clients really evaluate performance quality, they postulate that they compare
expectations earlier to, in receipt of the performance by means of their definite occurrence of
performance. Thus, when consumers’ needs are accomplished, performance excellence is
professed to be acceptable; if otherwise or contrary to the expectations, they are alleged to be
below the acceptable level and if it exceed, they are professed to be more than acceptable.
Ibok & Etuk (2013) suggest that there are rare empirical studies, investigating Nigerians’
attitude towards service quality on consumers’ satisfaction in service industry specifically
healthcare sector. Nevertheless, the decisive goals of institutions remain the provision of
modern, superior goods or services immediately in response to client expectation (Omale,
2016). Likewise, Kim & Lee (2012) examine connection among service excellence as well as
client support services as the key drivers that establish and maintain customers to the healthcare
providers. Similarly, Palaniammal, Jayalakshmi, & Saravanam (2015) argues that performance
84
excellence have a positive effect on clients’ happiness. Nevertheless, none of these studies used
gender equity as moderator between responsiveness and customers’ satisfaction. This is the
motivation for this research as it intends to broaden the horizon on gender equity moderating
the correlation among responsiveness as well as customers’ fulfillment with specific reference
to Federal Medical Centre, Keffi (FMC), Nasarawa State in Nigeria.
Furthermore, Iliyasu, Abubakar, Lawan, & Gajida, (2010) study public healthcare hospital in
Nigeria, and their finding depict that there is inconsequential correlation connecting service
excellence as well as customers’ happiness. Similarly, the study of Iloh et al. (2012) explore
Nigerian public healthcare institution; the result illustrates that there is considerable as well as
affirmative connection among service quality as well as customers’ fulfillment in healthcare
sector. However, they failed to incorporate moderator in their study because the findings of
these studies reported contradictory findings in relationships between variables of interests. To
this effect, Baron & Kenny (1986) suggest that, for studies that empirically shown
inconsistency in the findings should apply moderator. Thus, this study used moderator and it
serves as a gap to the literature.
Against this backdrop, it becomes very pertinent to investigate the extent to which gender
equity moderate the connection involving responsiveness as well as consumers’ satisfaction in
FMC, Keffi, Nasarawa State. The study therefore examines one research objective that links
responsiveness with patients’ satisfaction using gender equality as moderator. To find out the
extent to which responsiveness affect patients’ satisfaction in the FMC, Keffi, Nasarawa State.
To find out the degree to which gender equity moderates the correlation among responsiveness
as well as patients’ satisfaction in the FMC, Keffi, Nasarawa State. The article is separated into
five sections. The opening part is related to the introduction. The subsequent part is concerned
with the literature review. Methodology covers the third part of the paper; results and
discussion of findings is the fourth section. Lastly, the fifth segment is the conclusion in
addition to suggestions for the paper.
2. Literature review
Client contentment can be viewed as attaining the desired expectations of clients in as regard
to the parameters linked with satisfaction (Sabir et al., 2013). It is argued that consumer
fulfillment is the way that leads to lasting client retention since displeased customer has
extremely high tendency for changing rate (Sabir et al. 2013). Zairi (2000) opined that the
emotion of achievement of internal needs is called fulfillment. Service quality has straight
impact on consumer satisfaction (Oliver, 1998; Mittal & Lassar, 1998). If performance meets
the desires as well as the demands of the customers, there is tendency to be satisfied and be
converted to satisfied customer of the firm. Sabir et al. (2013) opined that client fulfillment is
85
the hub idea of marketing tactic of any firm as it plays a vital part in the accomplishment of
any given organization. Thus, consumer contentment is the cardinal principle of modern
marketing tool applies by marketers to attract and retain customers. Similarly, consumer
contentment refers to individual emotion of happiness or dissatisfaction ensuing based on the
appraisal of performance rendered by an institution to a person in connection to expectation
(Loke, Taiwo, Salim, & Downe, 2011).
Those that render services often put a higher precedence on consumer contentment since it has
been seen as a condition for customer patronage. Omale & Dauda (2021) maintain that
satisfaction requires deliberate policy which signifies organizational broad arrangement
between employees as well as stakeholders concerning what denote success and how it can be
achieved. As an affirmative result of marketing actions, elevated client fulfillment leads to
replicate visitation to stores, replicate service purchases as well as statement of encouragement
to associates (Loke et al. 2011). Meanwhile, little consumer contentment has been connected
with complaints, a pleased client frequently stays connected and they are prone to utilize the
organization in future (Kotler & Armstrong, 2006). The more an organization provides superior
services to the customers the more satisfaction occurs. Though, securing as well as growing
client satisfaction is hinge to numerous business strategies since obtaining novel clients is
expensive as well as client happiness is associated to lasting service superiority. Therefore,
Kuei (1998) argues that service superiority might be engaged as a tactical tool to put together
a distinguishing benefit for organizations in the market.
Receptiveness is connected with the interaction with patients in the span of moment that needs
to stay for help, answers to questions, or pay interest to challenges. Responsiveness captures
the idea of flexibility as well as capability to modify the service to clients’ needs. In the counsel
of Zeithaml, Bitner, & Gremler (2009), in order to do extremely well on the breadth of
receptiveness, a firm has to sight procedure of discharging service as well as the management
of needs related to clients’ position of things instead of organizations’ point of view.
Moderating variable is a self-determining variable which affects ways or the potency of
connection among self-determining as well as dependent variable (Thompson, 2006).
2.1 Empirical review
Perceived service quality is optimistically linked to customer’s fulfillment in short terms;

however predictable performance was certainly connected in mutually short as well as long
terms (Ahmed, Nawaz, Usman, Shaukat, Ahmad & Iqbal (2010). Lai (2004) find affirmative
bond linking tangibility, empathy, assurance as well as customer’s satisfaction. Similar finding
was specified by Cronin & Taylor (1992) in their study. The study conducted by Arslan,
Iftikhar & Zaman (2015) which sought to establish the consequence of performance excellence
86
proportions on Customers’ happiness shows that empathy as well as assurance have positive
significant effects on consumers’ satisfaction in hospitals.
Similarly, the study conducted by Lin & Vassar (2004) identifies customers’ attitudes toward
satisfaction on mobile healthcare services. The finding depicted that performance quality have
connection with the client satisfaction. Baumann, Burton, Elliot & Kehr (2007) find out that
emotional attitude, empathy as well as consumer fulfillment lead the clients towards additional
suggestion to extra users. Responsiveness leads to short term preservation at the same time,
affective attitude as well as empathy have protracted impact on client’s contentment as well as
retention.
2.2 Theoretical framework
The Gap Model is used for this study:

Gap 1: The gap represents client desires - administrator perceptions gap. This hole presents
itself as the disparity in hope as well as views concerning safety as well as solitude. Deficiency
in communication among decision-making executive as well as patients leading to confusion
of mutually the demands as well as desires necessary to be satisfied to advance patient
contentment ratings. The hypothetical analysis which preside over this gap comprise: market
study direction, growing communiquéas well as the amount of administration which client
contact workers desire to work through (Zeithaml et al., 2009).
Gap 2: Healthcare amenities as well enchanter troubles while commenting on the services
anticipated from patients. This gap is the disparity among the executive view of patient hope
as well as service quality stipulation. The constructs which rule this gap comprise aspects of
management dedication to service quality, goal-setting, job reliability and opinion of possibility
(Zeithaml et al., 2009; Zeithaml, 2010).
Gap 3: Is the disparity among service quality stipulation as well as the real service delivered.
This is a particularly hard part owing to the discrepancy of patients’ conduct.
Gap 4: This entails service delivery as it were as well as outside interactions gap. Healthcare
amenities do not all the time do well in notifying patients of their activities to get together with
their anticipation as well as fulfills on the promises. Consequently, client’s hopes are not
associated to the objectives as well as tactic of the facility. However, patients that know what
they are entitled to, will experience a lesser amount of disagreement in the expectations against
opinion gap.
Gap 5: This gap is explained the intensity of service anticipated from the donor against the
apparent service. Potential are regarded as the principles the patient applies to the service
87
knowledge, whereas perceptions are the biased examination of the real information. Declining
this gap is very vital for healthcare services to guarantee fulfilled patients.
Likewise, responsiveness is the readiness of service providers to present timely service as well
as assist clients. This aspect according to Zeithaml, Bitner, & Gremler (2009)) emphasizes
attention as well as swiftness in dealing with patient’s questions, desires, challenges as well as
complaints. Clients are informed of receptiveness via the span of period they are required to
stay for help, provides solutions to questions, or attention to challenges. Zeithaml et al., (2009)
posit that service excellence might improve via openness, for instance, if employees react
properly to a patients’ demand for timely service. This encouraged the stated hypothesis
formulation below:
H01: There is no considerable correlation linking responsiveness as well as patients’ fulfilment
in FMC, Keffi, Nasarawa State.
The five quality service model was described by Parasuraman, Zeithaml & Berry (1985) as an
extension on the SERVQUAL instrument and it is ruled by the belief of constant development
of five traits; excellence of thing; superiority of procedure; excellence of infrastructure;
excellence of communication; excellence of environment with stress on relationship building.
This article is based on the idea that using Gap viewpoint method is most suitable in the
evaluation of service superiority opinion as well as satisfaction correlation. This engenders the
formulation of this proposition:
H02: Gender equality does not significantly moderate the correlation among responsiveness as
well as patients’ satisfaction in FMC, Keffi, Nasarawa State.
Figure 1: Research Model
Responsiveness Patients Satisfaction

Satisfaction
Gender
equalit
y
Source: Researchers’ conceptualization, 2022.
88
3. Methodology
This research used statistical tool such as Partial Least Square and Structural Equation
Modeling (PLS-SEM) using SmartPLS 3.0 version to examine the postulated hypothesis in this
study. The use of PLS-SEM in this research becomes imperative since predictive accuracy is
paramount as compared to other methodologies of SEM such as: Covariance Based-SEM (CB-
SEM); Generalized Structural Component Analysis (GSCA), and others. The method of
measuring unobservable construct for this study is reflective measurement. As a result,
SmartPLS assume all indicators to be reflective. Similarly, Microsoft version 22.0 was used to
process data for this article.
The staff strength for this research is made up of all the in-patients of the hospital who are
adults, and are living in Federal Capital Territory, Abuja (FCTA). The choice of the FCTA is
necessitated by the fact that patients from the FCTA reflected the whole ethnic groups and
cultures in Nigeria. Thus, the result of this study could be generalised to the entire healthcare
sector in Nigeria. Probability sampling technique was adopted in the assortment of population
for this paper. The method provided each person (patient) the same chance or opportunity of
being chosen as the sample object (Sekaran, 2003). Thus, a total of two hundred and twenty
(220) respondents participated in this study. Twenty (20) of the opinion polls were removed
because it constituted unreturned values and two hundred (200) were returned and used for this
study.
Bootstrap method is followed for statistical testing of hypothesis for this study. Therefore,
while the dimension of the resultant experimental t-value is above 1.96 level of confidence it
could be said that the pathway coefficient is significant at the level of probability of 0.05
percent. Hence, the lower bound of bootstrap confidence interval is -1.96 and upper bound
+1.96. This means that a null hypothesis (Ho) that is less than 1.96 confidence is rejected and
otherwise, supported.
4.1. Measurement and instrument
The tool adopted or designed for the research is prearranged questionnaire. The opinion poll
designed for this paper is modified on the basis of previous study such as (Boshoff & Gray,
2004). Thus, prearranged opinion poll is the basis for information gathering for this paper. 5
point Likert-scale ranking ranging from Strongly Agree (SA); Agree (A); Undecided (U);
Disagree (DA); as well as Strongly Disagree (DA). The prearranged opinion poll comprises of
two major components: part A as well as B. Special data of employees and patient like sexual
characteristics, age, marital status, as well as level of education. Part B includes questions
concerned to the construct of this study that is responsiveness.
89
4.2. Internal consistency reliability
Sarstedt, Ringle, Smith, Reams, & Hair (2014) argue that composite dependability should be
above 0.70 although they suggest that a composite dependability of 0.60 to 0.70 is satisfactory
in investigative study. The standard PLS algorithm result for this study indicates that the latent
variable in the model has composite reliability of not less than the estimation of 0.6 to 0.70
(Sarstedt et al., 2014). Thus, responsiveness 0.825 and customer satisfaction is 0.824.
Table 1: Summary of Measurement Model Results
Construct Items Loadings Composite AVE

Reliability
Responsiveness RP1 0.883 0.825 0.617
RP2 0.833
RP3 0.675
Customer CS1 0.882 0.824 0.612
Satisfaction CS2 0.769
CS3 0.683
Note: AVE = Average variance extracted, CR= Composite Reliability
Source: SmartPLS Version 3.0 Output, 2021.
4.3. Convergent validity and discriminant validity
Convergent legitimacy can be regarded or referred to the degree of an agreement among several
indicators in measuring the same construct (Sarstedt et al., 2014). The Average Variance
Extracted (AVE) remains the total average of the squared loadings of the indicators connected
with the latent variable (Sarstedt et al., 2014). Customer satisfaction has an AVE of 0.612 and
responsiveness AVE is 0.617 (see table 1).Tables 2 and 3 output are used to assess discriminant
validity for this study. As a result, discriminant validity implies the degree of indicators
differentiated the construct it is associated with from other constructs in the model (Sarstedt et
al., 2014). The earliest technique is by examining the indicators cross-loadings. The cross-
loading criterion is considered a more open-minded technique of assessing discriminate
legitimacy (Hair, Ringle & Sarstedt, 2011). Chin (1988) argues that the indicators of external
load on the construct it represents must be superior to all its loadings on other constructs. Next
criterion for assessing discriminant validity is through the Fornell & Larcker (1981) criteria.
The principle suggested that for discriminant legitimacy to be confirmed the square root of
90
AVE for a particular construct must be superior to its relationship with any other construct in
the model.
Thus, the Fornel & Larcker criterion for this study recommends that the constructs discriminant
is fit, since the square root of the AVE of each thoughtful construct is bigger than the
correlations with the residual constructs in the model. Thus, (0.782) customer satisfaction;
(785) responsiveness (see table 3).
Table 2: Discriminate Validity using Fornell & Larcker Criterion

Customer Satisfaction Responsiveness
Cust. Sat 0.782
Responsiveness 0.682 0.785
Source: SmartPLS version 3.0 Output, 2021.
Table 3: Cross-Loading of items

Items Customer Satisfaction Responsiveness
CS1 0.882 0.651
CS2 0.769 0.504
CS3 0.683 0.414
RP1 0.673 0.883
RP2 0.551 0.833
RP3 0.286 0.675
Source: SmartPLS 3.0 Output, 2021.
The structural model with interacting term below shows how gender moderates the connection
among responsiveness as well as customers’ contentment (patients’ satisfaction) for this study.
91
Figure 2: Structural model with interacting term
Source: SmartPLS-SEM version 3.0 Output, 2021.
4.4. Indicator reliability
The indicator reliability is calculated on the basis of indicators’ external variables, and it is
referred to the level of association between the indicators. Hulland (1999) offered 0.4 as a lower
limit and suggested that anything among external loading of < 0.40 ought to be deleted from
the measurement scale. The exogenous latent variable recorded indicators above the minimum
threshold of 0.4 and close to maximum value of 0.7 and above. Thus, responsiveness recorded
(RP1 0.883, RP2 0.833, RP3 0.675) and patient satisfaction recorded (CS1 0.882, CS2 0.769,
CS3 0.683).
4.5. Results and discussion of findings
The finding of this study provides that, there is no considerable correlation linking
responsiveness as well as patients’ satisfaction in FMC, Keffi, Nasarawa State. Gender norms
do not manifest in the relationship between responsiveness and patients’ satisfaction in the
healthcare system and thus, does not strengthen gender inequalities as well as satisfaction of
patients. The R2 for this paper model was established to be 0.465. Therefore, match with (Hair
et al., 2011; Henseler, Ringle, & Sincovics, 2009) criteria it was moderate. Based on R2 showed
with the value of 0.465 implies that the exogenous variable like responsiveness moderately
explained 46 percent of the variation in endogenous variable (client fulfillment). The remaining
92
54 percent of the inconsistency is evaluated via other variables not mentioned in the scope of
this paper.
Besides, the outcome of the SmartPLS analysis for the first hypothesis (Ho1) analysis also
provides that, there is no considerable correlation linking responsiveness as well as patients’
satisfaction in FMC, Keffi, Nasarawa State. Gender norms do not manifest in the relationship
between responsiveness and patients’ satisfaction in the healthcare system and thus, does not
strengthen gender inequalities as well as satisfaction of patients. The t-value of 1.948 is < 1.96
confidence and p-value of 0.052 which is > 0.05% level of significance. Responsiveness is not
found to considerably affect patients’ satisfaction in the hospital (β= 0.157, t= 1.948, p> 0.052)
yet with strong positive coefficient (β). The outcome does not concur with previous discovery
of Ehsan, et al., (2015) that evaluated the impact of service excellence on patient happiness in
private hospital in Iran.
Outcome from the SmartPLS analysis for (Ho2) test also show that gender equity in-
significantly moderate the correlation linking responsiveness and patients’ satisfaction in FMC,
Keffi, Nasarawa State. Therefore, gender-friendly healthcare services affect patients’
faithfulness as well as readiness to pay. The t-value of 1.029 is less than 1.96 level of
confidence (β= 0.524, t= 1.029) with a strong positive coefficient (β). The result is not
consistent with prior result of (Alisadar & Rahim, 2017). This non-significant relationship is
such that the effect of responsiveness is the same for the gender in the hospital. This implies
that the gender show the same level of clients’ dissatisfaction in the hospital.
5. Conclusion and recommendations

It is observed that gender equity do not considerably moderate the correlation involving
responsiveness and patients’ happiness in the hospital. The level of main concern dedicated
into the above service quality indicator translated into lack of patients’ happiness in the
hospital. This, by inference implies patients’ satisfaction in the hospital over the period studied.
Healthcare institutions and their managements are considerably accountable in addressing
responsiveness, gender inequalities as well as patients’ satisfaction. Given the perseverance of
restraining gender norms inside systems, with a progressive programmes and policies, one can
certainly conclude that sustaining existing programmes as well as novel approaches are desired
for responsiveness and patient satisfaction in the healthcare sector of Nigeria economy. Dale,
Van Der Wiele & Van Iwaarden (2007) describe responsiveness as the readiness to help clients
as well as provide appropriate service on a steady basis. This component focused on attention
as well as readiness to relate as well as deal with customers’ wishes, inquiry in addition to
timely grievance resolution. In the counsel of Zeithaml et al. (2009), to do extremely well on
93
the dimension of receptiveness, an organization should see procedure of delivering service as

well as management of wishes from the clients’ position of things instead of the organization
point of view. Also, responsiveness showed in-significant with patients’ satisfaction in the
hospital. Consequently, the management has to stimulate responsiveness and/or be sensitive to
patients’ satisfaction in the hospital while formulating policies relating to patients’ satisfaction.
Similarly, they should be deliberate efforts to encourage the executives in putting more effort
into enhancing the professional training of physicians, rather than developing policies
programmes. The study further recommended that management should not employ gender
equity as it had no positive relationship between gender and responsiveness to improve
patients’ satisfaction in the hospital.
Acknowledgements
We appreciate the contributions of the reviewers, editor in chief as well as the staff and
management of the selected hospital that is, FMC Keffi Nasarawa State, Nigeria for their hard
to forget contributions and role played for the success of this article. May God reward you all!
Conflicts of Interest
There is no conflict of interest before, during and after the course of this investigation.
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Moderating Effects of Gender Equality On Responsiveness and Patients

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Moderating Effects of Gender Equality On Responsiveness and Patients

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Moderating Effects of Gender Equality on Responsiveness and

Abdullahi Dauda1 , Sunday Alewo Omale1 , Abdullahi Mohammed2

2.1 Empirical review

Perceived service quality is optimistically linked to customer’s fulfillment in short terms;

2.2 Theoretical framework

The Gap Model is used for this study:

Figure 1: Research Model

Responsiveness Patients Satisfaction

Source: Researchers’ conceptualization, 2022.

4.1. Measurement and instrument

4.2. Internal consistency reliability

Table 1: Summary of Measurement Model Results

Construct Items Loadings Composite AVE

4.3. Convergent validity and discriminant validity

Table 2: Discriminate Validity using Fornell & Larcker Criterion

Source: SmartPLS version 3.0 Output, 2021.

Table 3: Cross-Loading of items

Figure 2: Structural model with interacting term

Source: SmartPLS-SEM version 3.0 Output, 2021.

4.4. Indicator reliability

4.5. Results and discussion of findings

5. Conclusion and recommendations

the dimension of receptiveness, an organization should see procedure of delivering service as

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